Efficacy and Safety of Intravenous Thrombolysis with Tenecteplase in Patients with Wake-Up Branch Atheromatous Disease
Research article published in Translational stroke research (2026)
Abstract
Branch atheromatous disease (BAD), a subtype of acute ischemic stroke (AIS), is associated with a high risk of early neurological deterioration (END) and poor prognosis. Wake-up stroke (WUS), comprising 20%-30% of AIS cases, is typically excluded from thrombolysis because of unknown onset time. Using diffusion-weighted imaging/fluid-attenuated inversion recovery (DWI/FLAIR) mismatch, we evaluated the efficacy and safety of Tenecteplase (TNK) thrombolysis in patients with BAD-related WUS. We retrospectively recruited 1,062 patients from seven Zhengzhou hospitals between January 2021 and June 2025. The patients received either TNK (n = 338) or dual antiplatelet therapy (n = 724). Propensity score matching (PSM; 1:1, caliper 0.02) yielded 292 matched pairs. Early neurological changes were evaluated using the National Institutes of Health Stroke Scale (NIHSS), and 90-day outcomes were evaluated using the modified Rankin Scale (mRS). After PSM, TNK significantly reduced the risk of END (odds ratio [OR] = 0.425, 95% confidence interval [CI]: 0.262-0.689; P < 0.001). Patients treated with TNK were more likely to achieve good functional outcomes (modified Rankin Scale [mRS] 0-1 and 0-2) with fewer poor outcomes (mRS ≥ 4). There were no significant differences in symptomatic intracranial hemorrhage, other bleeding events, or mortality among the groups. DWI/FLAIR mismatch-guided TNK thrombolysis appears to overcome the limitations of an unknown onset time in WUS and may counteract the progressive pathophysiology of BAD. TNK intravenous thrombolysis may be a safe and effective treatment for patients with wake-up BAD and DWI/FLAIR mismatches.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
This retrospective propensity-matched study of 292 paired wake-up branch atheromatous disease stroke patients found tenecteplase reduced early neurological deterioration versus dual antiplatelet therapy (OR 0.425, 95% CI 0.262-0.689). Bleeding and mortality were comparable between groups.
Why This Matters for Hirudotherapy
This retrospective multicenter study compared tenecteplase (TNK) thrombolysis against dual antiplatelet therapy in 1,062 patients with wake-up stroke from branch atheromatous disease, using DWI/FLAIR mismatch to select patients of unknown onset time; after 1:1 propensity-score matching (292 pairs), TNK significantly reduced early neurological deterioration (OR 0.425, 95% CI 0.262-0.689; P < 0.001) and improved 90-day functional outcomes with no significant increase in symptomatic intracranial hemorrhage. For ASH this sits in the broader thrombolytic/antithrombotic landscape that frames why leech-derived anticoagulants are studied: it documents how a fibrin-targeting agent is weighed for benefit versus bleeding, the same risk-benefit axis that governs any hirudin- or hementin-class molecule. The caveat is substantial: this is observational (non-randomized) data from a single region and does not involve leeches or leech-derived compounds, so it is contextual background only, not evidence for hirudotherapy.
Citation
Efficacy and Safety of Intravenous Thrombolysis with Tenecteplase in Patients with Wake-Up Branch Atheromatous Disease.
Zhu et al. · Translational stroke research, 2026
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